Search

Background: The exact anatomical entity behind the term superficial musculoaponeurotic system (SMAS) remains poorly understood. The different interpretations of the term SMAS by anatomists, surgeons, and histologists have caused confusion. This article aims to provide clarity regarding this term and the relevant anatomy., Methods: A literature review was conducted to uncover the variety of descriptions of the term SMAS. A feasibility study, followed by a conclusive series of standardized layered dissections complemented by histologic analysis and sheet plastination, was performed on 50 cadaver heads (16 embalmed and 34 fresh; mean age, 75 years)., Results: Most literature considers the SMAS as layer 3, that is, a musculoaponeurotic layer that separates the subcutaneous fat of the superficial fascia from the deep fat of the deep fascia. The authors' dissections, histologic analysis, and sheet plastination demonstrated that layer 3 is present only where there are flat mimetic muscles and platysma-auricular fascia over the posterior part of the parotid gland as the evolutionary remnant of the platysma, but not between the flat mimetic muscles. Here, the subcutaneous fat is in direct contact with the deep fat without the interposition of a musculoaponeurotic layer 3., Conclusions: Because of the absence of a distinct and complete layer 3 connecting the flat mimetic muscles, the authors conclude that the SMAS as originally described does not exist as a specific anatomical entity. In retrospect, the surgically created compound layered flap composed of a variable thickness of subcutaneous fat, mimetic muscles (eg, platysma, orbicularis oculi), and a thin layer of deep fascia is what is known as the "SMAS.", (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.)

The purpose of this study was to clarify the subcutaneous structures involved in the morphology of the gluteal region for clinical application. Thirty-seven formalin-fixed cadavers and one soft-fixed cadaver were used in this study. Gluteal tissue was removed from five formalin-fixed cadavers. A horizontal section and sections parallel to the long axis of the body were made from the excised tissue, and the subcutaneous fat was removed to observe the fibrous structure within the subcutaneous fat. Two formalin-fixed cadavers and one soft-fixed cadaver were used to perform conventional gross anatomical dissection and histological examination. On 30 formalin-fixed cadavers, the thickness of the subcutaneous fat was measured in various areas of the buttocks. The thickness of subcutaneous fat was thicker in the center of the buttocks and thinner on the lateral buttocks. Superficial fascia (SF) was found only in the upper buttock, being indistinct in the lower buttock. In the sacral and coccygeal areas, the dermis was tightly adhered to the bone as a single mass. Fibers arose from around the iliac crest to the SF. On the medial side of the gluteal fold, a strong fiber arose from the sciatic tubercle and inserted into the gluteus maximus and dermis. By identifying the characteristic subcutaneous structures of the gluteal region, we were able to identify the anatomical structures that shape the three-dimensional morphology of the buttocks. These findings may be useful in surgical treatments such as improving the buttock shape., (© 2022 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

The characteristics of the superficial musculoaponeurotic system (SMAS), including the morphology of each part and the connection between tissues, remain controversial. The purpose of this study is to clarify the anatomy of the SMAS using our new dissection method. In this study, six hemi-sides of heads from formalin-preserved cadavers were used. Three were used for creating a horizontal section and three were used for creating the section along the axial line perpendicular to the surface of the skin, resulting in a gradual change from the coronal section at the lateral to the sagittal section at the median. The resected head was cut into slices with widths of 7 mm. The stretched tissue dissection method was performed by fixing a tissue slice to a board and pulling the skin outward to stretch the soft tissue. Blunt dissection was then performed under a microscope. The SMAS comprises three layers: superficial, intermediate, and deep. The superficial layer is a thin membrane directly connecting to the septa in the subcutaneous fat. The deep layer is the connective tissue in contact with the sub-SMAS structure. The layer surrounded by the superficial and deep layer of the SMAS is the intermediate layer, containing connective tissue, adipose tissue, and facial muscles. The detailed findings of the SMAS obtained using this method resolve theoretical discrepancies and provide important insight for the field of facial surgery., (© 2022 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Background: Body mass index (BMI), waist and hip circumference are strongly correlated and do not reflect body composition. A Body Shape Index (ABSI) and Hip Index (HI) define waist and hip size among individuals with the same weight and height and would thus reflect body density. We examined differences in body composition between body-shape phenotypes defined with ABSI and HI and used this information to propose explanations for associations between body-shape phenotypes and colon cancer risk., Methods: We used data from the UK Biobank Resource for 15,520 men, 16,548 women with dual-emission X-ray absorptiometry (DXA) measurements; 3997 men, 4402 women with magnetic resonance imaging (MRI) measurements; 200,289 men, 230,326 women followed-up for colon cancer. We defined body-shape phenotypes as: large-ABSI-small-HI ("apple"), small-ABSI-large-HI ("pear"), small-ABSI-small-HI ("slim"), large-ABSI-large-HI ("wide"). We evaluated differences in body composition in linear models and associations with colon cancer risk in Cox proportional hazards models adjusted for confounders and explored heterogeneity by BMI., Results: Among individuals with the same height and weight, visceral adipose tissue (VAT) was lowest for "pear" and highest for "apple", while abdominal subcutaneous adipose tissue (ASAT) was lowest for "slim" and highest for "wide" phenotype. In the gynoid region, differences between "apple" and "pear" phenotypes were accounted for mainly by fat mass in women but by lean mass in men. In men, lean mass was inversely associated with waist size, while the pattern of gynoid fat resembled ASAT in women. Lean and fat mass were higher for higher BMI, but not hand grip strength. Compared to normal weight "pear", the risk of colon cancer in men (1029 cases) was higher for "apple" phenotype for normal weight (hazard ratio HR = 1.77; 95% confidence interval: 1.16-2.69) and comparably for overweight and obese, higher for "wide" phenotype for overweight (HR = 1.60; 1.14-2.24) and comparably for obese, but higher for "slim" phenotype only for obese (HR = 1.98; 1.35-2.88). Associations with colon cancer risk in women (889 cases) were weaker., Conclusions: ABSI-by-HI body-shape phenotypes provide information for body composition. Colon cancer risk in men appears related to ASAT quantity for "slim" and "wide" but to factors determining VAT accumulation for "apple" phenotype., (© 2021. The Author(s).)

Introduction: To reduce complications caused by the procedure, the target layer for thread lifting should be the superficial fat or superficial musculoaponeurotic system of the face. The aim of this study was to establish the thicknesses of the facial skin and superficial fat using a 3D scanning system to provide basic clinical data for thread lifting., Material and Methods: Thirty fixed Korean and Thai cadavers (male: 17, female: 13) were used. The depths of the skin and superficial fat were measured using a three dimensional (3D) structured-light scanner. Facial images of both undissected and removed skin and superficial fat were taken with the 3D scanner. The paths from the temple and the front of the tragus to the infraorbital, perioral, cheek, and mental areas were displayed on the 3D image. The thickness along the path was measured by calculating the difference between the undissected and dissected 3D images., Results: The means and standard deviations of thicknesses of the skin and superficial fat were 2.1 ± 0.4 mm and 5.2 ± 1.9 mm in the 11 pathways. The facial skin became thicker going toward the lower aspect of the face from temple to infraorbtial and perioral regions. The thickness of the superficial fat around the marionette line showed the biggest change., Conclusions: The present findings indicate that a 3D scanning system can yield crucial anatomical information about the thickness of the facial skin and superficial fat for use in various minimally invasive clinical procedures including thread lifting., (© 2021 American Association of Clinical Anatomists.)

A portable ultra-wide band microwave system (MiS) coupled with an open-ended coaxial probe (OCP) or Antipodal Vivaldi Antenna (VPA) was tested as a non-invasive objective measurement to predict beef carcase single site fat depth at commercial abattoirs. Experiment one tested the effectiveness of MiS coupled with a VPA. The VPA was used to predict hot carcase P8 (fat depth on the rump) across 4 slaughter groups (n = 241). The VPA was also used to predict cold carcase rib fat (at the quartering site, 75% along the rib eye muscle) across 5 slaughter groups (n = 598). Experiment two tested the ability of MiS coupled with OCP to measure hot carcase P8 across two slaughter groups (n = 435). A machine learning stacking ensemble method was used to create the prediction equations. Datasets were grouped by prediction trait (P8 or ribfat) and probe/antenna then randomly divided into 5 groups based on tissue depth. Precision was greatest using OCP to predict P8 fat depth with a RMSEP of 2.47 mm and R2 of 0.70. The VPA precision was similar for the two tissue depths assessed, hot carcase P8 had an average RMSEP of 2.86 mm and R2 of 0.58 compared to cold carcase rib fat RMSEP of 2.60 mm and R2 of 0.55., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the reliability and validity of a standardized ultrasound examination protocol for measuring vastus lateralis muscle size., Design: Prospective cohort study., Subjects: Sixteen staff members of the university hospital of Heidelberg., Methods: Muscle thickness, cross-sectional area and subcutaneous adipose tissue thickness were measured at 3 standardized sites on the right and left vastus lateralis muscle. Ultrasound measurements were collected by 2 independent investigators on 2 different days and compared with magnetic resonance imaging measurements., Results: Intraclass correlation coefficients (ICC) for intra- and inter-rater reliability showed very good closeness of agreement for all parameters (ICC = 0.929-0.994, p < 0.001). Muscle thickness and subcutaneous adipose tissue thickness ultrasound and magnetic resonance imaging measurements revealed good to very good closeness of agreement (ICC = 0.835-0.969, p < 0.001), whereas cross-sectional area showed only average closeness of agreement (ICC = 0.727, p < 0.001). A strong predictive positive correlation for ultrasound and magnetic resonance imaging-based measurements of cross-sectional area was found (R² = 0.793, p < 0.001)., Conclusion: By standardization of an examination protocol, quantitative vastus lateralis muscle ultrasound proved to be a reliable method for assessing vastus lateralis muscle size. Furthermore, this protocol is valid for measuring muscle thickness and subcutaneous adipose tissue thickness, although there seems to be a systematic underestimation of cross-sectional area depending on subcutaneous adipose tissue thickness.

The increased popularity of the bikini-physique competitions has not translated to greater research identifying the influence of age on adaptations during contest preparation. The purpose of this case series was to observe how age may influence the adaptations normally seen during preparation and the exploration of newer protocols to address adaptations more relative to the judging standards. Over a 16-week pre-contest preparation, a 32-y bikini competitor (BC) and 44-y master's bikini competitor (MBC) visited the laboratory bi-weekly to observe changes in body fat mass (BF), lean body mass (LBM), bone mineral density (BMD), total body water (TBW); exploratory measures of deltoid cross-sectional area (Delt CSA ), gluteus maximus muscle thickness (GM MT ), and subcutaneous adipose tissue thickness (SAT); reproductive hormones estradiol (E2), luteinizing hormone (LH), and energy balance hormones triiodothyronine (T 3 ), leptin and ghrelin; hydration status during contest preparation and the week of competition; resting metabolic rate (RMR); psychometric data related to perceived anxiety, stress, and body image were assessed. No differences between BC and MBC were observed in BF, LBM, BMD, and TBW. Both competitors showed a small loss in LBM. Both BC and MBC showed a contrasting increase in Delt CSA and a loss in GM MT . MBC showed to be slightly more dehydrated (1.025 vs 1.021 g·mL - 1 ) than BC. Both competitors maintained a euhydration status the day of the competition. No time differences were found between BC and MBC during RMR. BC showed a higher mean difference RMR compared to MBC (2.66 ± 0.75 kcal·kgLBM - 1 ·d - 1 ). MBC showed a higher mean difference in LH concentration (84.6 ± 6.01 IU·L - 1 ), which may be explained by perimenopausal status. MBC had a higher mean difference concentration of leptin (2.51 ± 0.24 ng·mL - 1 ·kgFM - 1 ), which was unperturbed by fat loss may be interrelated LH. BC self-reported a higher mean energy intake (15.07 ± 3.43 kcal·kgLBM - 1 ·d - 1 ) and higher aerobic training volume (93.26 ± 40.68 min·d). BC and MBC showed similar composition changes, slightly differing metabolic rates, and differing hormonal LH and leptin responses. This finding is in contrast to previous work showing both LH inhibition and leptin diurnal disturbance in younger, female athletes with low energy availability. The exploratory measures may have some benefit for bikini-physique competitors related to the judging criteria. Age did not seem to play a role in contest preparation adaptations.

Background & Aims: Accurate and reproducible biomarkers are required to allow a more personalized approach to patient care. Body composition is one such biomarker affecting outcomes in a range of surgical and oncological conditions. The aim of this study is to determine the age and sex specific distribution of body composition data, based on information gathered from computed tomography (CT)., Methods: This prospective study used healthy subjects from the medical records linkage of the Rochester Epidemiology Project, based in Minnesota, USA. Each patient had a CT scan without intravenous contrast performed between 1999 and 2001. Quantification was performed using previously validated semi-automated in-house developed software for body composition analysis. Subcutaneous adipose tissue area, visceral adipose tissue area, intermuscular adipose tissue area and skeletal muscle area were measured and indexed to subject height. Generalized Additive Models for Location, Scale and Shape were used to assess the location, scale, and shape of each variable across age, stratified by sex. Z-scores specific to sex were assessed for each of the parameters analyzed. Age-specific z-scores were calculated using the formula: Z = (Index Variable - μ)/σ or Z = (√ (Index Variable) - μ)/σ., Results: There were 692 subjects enrolled in the study. The fitted model equation was offered for each variable with values presented for μ and σ. Modelling with penalized splines was performed for VAT index, IMAT index and total adipose tissue index. Scatterplots of each variable were produced with lines of Z-scores as a visual representation., Conclusion: This study offers comparative data to allow comparison amongst multiple populations. This will form an important reference for future research and clinical practice., Competing Interests: Conflict of interest PJ Navin, MR Moynagh, EJ Atkinson, P Tirumanisetty, N Lebrasseur, A Kumar, S Khosla and N Takahashi all declare no conflict of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Body fat values obtained with various measurement methods deviate substantially in many cases. The standardised brightness-mode ultrasound method was used in 32 Kenyan elite long-distance runners to measure subcutaneous adipose tissue thicknesses at an accuracy and reliability level not reached by any other method. Subcutaneous adipose tissue forms the dominating part of body fat. Additionally, body mass ( m ), height ( h ), sitting height ( s ), leg length, and the mass index MI 1  =0.53m/( hs ) were determined. MI 1 considers leg length, which the body mass index ignores. MI 1 values of all participants were higher than their body mass indices. Both indices for relative body weight were within narrow ranges, although thickness sums of subcutaneous adipose tissue deviated strongly (women: 20-82 mm; men: 3-36 mm). Men had 2.1 times more embedded fasciae in the subcutaneous adipose tissue. In the subgroup with personal best times below world record time plus 10%, no correlation between performance and body mass index was found, and there was also no correlation with sums of subcutaneous adipose tissue thicknesses. Within the data ranges found here, extremely low relative body weight or low body fat were no criteria for the level of performance, therefore, pressure towards too low values may be disadvantageous., Competing Interests: WM and AF contributed to the software development and may participate in the returns. The other authors declare that there are no conflicts of interest., (Thieme. All rights reserved.)

Background: Anatomical studies have identified separate superficial and deep facial fat compartments, leading some to theorize that volume loss from the deep midface causes overlying superficial fat pseudoptosis. Unfortunately, a paucity of evidence exists regarding whether facial fat volume is truly lost with age and, if so, whether it is lost equally or differentially from the superficial and deep compartments. The aim of this study was to quantify volume changes occurring with age within the superficial, deep, and buccal fat compartments of the midface., Methods: A retrospective longitudinal study was performed evaluating individuals aged 30 to 65 years who underwent facial computed tomography followed by facial computed tomography greater than or equal to 10 years later. Superficial midface, deep midface, and buccal fat volumes were quantified using Horos radiology software., Results: Nineteen subjects met inclusion criteria. Mean total fat volume decreased significantly from 46.47 cc to 40.81 cc (p < 0.01). The mean superficial and deep fat volumes both decreased significantly from 26.10 cc to 23.15 cc (p < 0.01) and from 11.01 cc to 8.98 cc (p < 0.01), respectively. No significant difference was observed in buccal fat volume over time (9.36 cc to 8.68 cc; p = 0.04). Patients lost an average of 11.3 percent of their initial superficial fat volume and 18.4 percent of their initial deep fat volume., Conclusions: Significant volume loss was observed from both superficial and deep facial fat compartments over a mean 11.3 years. Patients lost a greater percentage of deep facial fat volume, providing support for the theory of pseudoptosis caused by deep midface fat loss., (Copyright © 2020 by the American Society of Plastic Surgeons.)

The present study estimated genetic parameters and evaluated the genetic and phenotypic correlations between meat quality characteristics of Nellore cattle evaluated at different anatomical points of the longissimus. Data from 1329 Nellore young bulls were used to evaluate, in the 5th and 12th ribs, marbling score (MAR), shear force (SF), cooking weight losses (CWL) and intramuscular fat (IMF). In addition, the subcutaneous fat thickness was measured at the 12th rib (SFT 12 ) and between the last lumbar and the first sacral vertebrae (SFT LR ), in the separation of loin and round. Results yielded moderate heritability coefficients for evaluated characteristics, except CWL. High genetic correlations (0.61) were found between measurements of SFT 12 and SFT LR . MAR, IMF and SF were evaluated at the 5th and 12th rib. Meat quality and subcutaneous fat thickness measured at different anatomical points of the longissimus are genetically correlated and can be used in genetic selection programs to improve meat quality characteristics in Nellore cattle., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Summary: Facial aging is a multifactorial process governed by both intrinsic and extrinsic factors that impart a change to each component of the facial anatomy. Our understanding of the science of aging has evolved over the years. A recent and valuable addition to our understanding is the knowledge of both the superficial and deep facial fat compartments. The deep compartments provide structural support to the midface and the superficial fat compartments. Understanding the anatomy and the spectrum of their changes helps to tailor management options for facial rejuvenation. The authors present a review on facial aging as it relates to these fat compartments and provide a management algorithm based on the longitudinal changes seen during aging., (Copyright © 2020 by the American Society of Plastic Surgeons.)

Examiners with minimal training and skill are often called upon to make body composition assessments using field methods. This study compared the interrater reliability of novice examiners for the skinfold (SKF) and A-mode ultrasound (US) methods of body composition assessment. Undergraduate Kinesiology majors (48 males, 32 females) with minimal training took both SKF and US measurements at three sites (males: chest, abdomen, thigh; females: triceps, suprailiac, thigh). Interrater reliability was significantly better for US compared to SKF at the thigh (ICCUS = 0.975, ICCSKF = 0.912) and abdomen (ICCUS = 0.984, ICCSKF = 0.693) for men and suprailiac (ICCUS = 0.978, ICCSKF = 0.883) for women. Additionally, interrater reliability of the US method was superior to the SKF method for the estimate of male body fat percentage (ICCUS = 0.990, ICCSKF = 0.862). The 95% CI was generally narrower for the US method than the SKF method at each site. The interrater reliability of the US method was superior to or equal to the SKF method for measuring subcutaneous body fat when novice examiners took the measurements., Competing Interests: The authors have declared that no competing interests exist.

Background: Studies involving superficial facial fat compartments are few in number with conflicting results. Most of them involved small study groups and compared measurements between different populations of young and old subjects either on cadavers or living subjects., Objective: To clarify volumetric and dimensional changes in midfacial superficial fat compartment retrospectively in patients who underwent a repeat magnetic resonance imaging (MRI) without gross pathology., Materials and Methods: A total of 70 patients with a mean age of 60 years (range: 33-82 years) and a median elapsed time of 44.5 months (range: 32-64 months) between 2 MRIs were included. Magnetic resonance imaging scans were analyzed in the axial and sagittal planes to obtain measurements of the medial part of the superficial cheek fat. Superficial cheek fat was divided into 3 compartments. Thickness, width, and height were measured, and volumes were calculated for each compartment on both hemifaces., Results: Volume and thickness were decreased significantly in all compartments (p < .05). The width was decreased in superior and middle compartments, whereas increased in lower compartment indicating dislocation of the fat tissue (p < .05). Height was also significantly increased (p < .05). A subgroup analysis has shown that there was no significant difference between men and women., Conclusion: This study clarifies that aging is associated with a significant decrease in superficial midfacial fat tissue volume and thickness both in women and men. The decrease in width in upper and middle compartments, but increase in lower compartment suggests a volume shift within superficial fat tissue.

Background: Excess submental fat (SMF) can cause submental fullness resulting in negative perceptions of individuals. However, the impact of SMF on perceptions of social traits has not been well studied., Objective: To characterize the impact of SMF on external value judgments in adults in the United States., Methods: Respondents completed an online survey in which they reacted to statements about individuals with varying grades of SMF. Attributes were rated on a scale from 0 to 100 with higher scores for more positive attributes., Results: Similar proportions of respondents (N = 1996) indicated that women and men with double chins were less attractive than those without (91% and 90%, respectively). A double chin was more likely to be noticed on a woman than on a man (78% of respondents). With increasing SMF, individuals were perceived as significantly less likeable, intelligent, happy, active, and easygoing. Those with greater amounts of SMF were rated as significantly less attractive than those with less SMF. For all attributes, male respondents rated all individuals lower than female respondents did., Conclusion: Results from this study provide further evidence of negative perceptions of individuals with SMF. Aesthetics of the submental area, especially SMF, likely impact the overall assessment of attractiveness and social attributes.

Aims: Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA., Methods: We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient's preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified., Results: Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m 2 (IQR 27.0 to 33.0); female median 29.0 kg/m 2 (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m 2 ) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m 2 ); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001))., Conclusion: We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: Bone Joint J 2020;102-B(9):1146-1150.

Purpose: Aim of this study was to develop and evaluate a software toolkit, which allows for a fully automated body composition analysis in contrast enhanced abdominal computed tomography leveraging the strengths of both, quantitative information from dual energy computed tomography and simple detection and segmentation tasks performed by deep convolutional neuronal networks (DCNN)., Methods and Materials: Both, public and private datasets were used to train and validate DCNN. A combination of two DCNN and quantitative thresholding was used to classify axial CT slices to the abdominal region, classify voxels as fat and muscle and to differentiate between subcutaneous and visceral fat. For validation, patients undergoing repetitive examination (±21 days) and patients who underwent concurrent bioelectrical impedance analysis (BIA) were analyzed. Concordance correlation coefficient (CCC), linear regression and Bland-Altman-Analysis were used as statistical tests., Results: Results provided from the algorithm toolkit were visually validated. The automated classifier was able to extract slices of interest from the full body scans with an accuracy of 98.7 %. DCNN-based segmentation for subcutaneous fat reached a mean dice similarity coefficient of 0.95. CCCs were 0.99 for both muscle and subcutaneous fat and 0.98 for visceral fat in patients undergoing repetitive examinations (n = 48). Further linear regression and Bland-Altman-Analyses suggested good agreement (r 2 :0.67-0.88) between the software toolkit and patients who underwent concurrent BIA (n = 39)., Conclusion: We describe a software toolkit allowing for an accurate analysis of body composition utilizing a combination of DCNN- and threshold-based segmentations from spectral detector computed tomography., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fat-free mass as well as lean soft tissue mass is a surrogate for skeletal muscle mass and is often used for the normalization of several physiological variables or for the diagnosing of low muscle mass in older adults. However, both fat-free mass and lean tissue mass include nonskeletal muscle components such as the fat-free component of adipose tissue fat cells. A technique known as water-fat MRI provides a noninvasive and radiation-free assessment of the fat-free component of adipose tissue in humans. However, if this method is impractical or unavailable, some authors suggest that a constant value for the fat-free component of adipose tissue can be used as an indirect estimate. The purpose of this review is to examine the fat fraction percentage of white (subcutaneous) adipose tissue in adolescents and young/middle-aged/older adults measured by water-fat MRI and provide discussion on how the fat-free adipose tissue values from the water-fat separation method compare with the constant value used in previous studies. Calculated mean values for the percentage of fat fraction in subcutaneous adipose tissue were 86.9% in the overall sample, 86.4% in adolescents (3 studies), and 87.1% in young, middle-aged and older adults (7 studies). This is similar to the 85% value proposed in the classical studies but in the majority of studies the 85% estimate was outside of the 95% confidence interval (CI) of the water-fat MRI estimate. There may be several factors to consider that may affect the fat fraction percentage (e.g. reliability of the MRI estimate, age, sex, obesity, etc.), however, at this time there is insufficient evidence to determine the effect of each of these variables. If the measurement is reliable, then this might suggest that the 85% constant may need to be altered to better reflect the water-fat MRI estimate., (Copyright © 2018 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Background: The mid-upper arm circumference (MUAC) is a proxy for subcutaneous fat in the upper body and is a reliable screening measure for identifying individuals with abnormal regional fat distribution. The purpose of this study was to evaluate the association between MUAC and metabolic syndrome (MetS) in middle-aged and elderly individuals., Methods: We measured the MUAC in a cross-sectional sample with a total of 9787 subjects aged 40 years and older. The measurement of MUAC is performed on the right arm using a non-elastic tape held midway between the acromion and the olecranon processes in duplicate, with the arm hanging loosely at the side of the body. The MetS was defined according to the Joint Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention., Results: MUAC was positively correlated with waist circumference (r = 0.437, P < 0.001), BMI (r = 0.334, P < 0.001), fasting insulin (r = 0.348, P < 0.001), HOMA-IR (r = 0.134, P < 0.001), triglycerides (r = 0.138, P < 0.001), SBP (r = 0.124, P < 0.001), and DBP (r = 0.123, P < 0.001), and inversely correlated with adiponectin (r = - 0.147, P < 0.001) and HDL-cholesterol (r = - 0.176, P < 0.001) after adjusting for age and gender. Compared with the lowest quartile group, the odds ratios were substantially higher for MetS (OR 1.77; 95% CI 1.51-2.09, P for trend< 0.001) in the highest MUAC quartile group after adjustment for potential cofounder., Conclusion: Large mid-upper arm circumference is significantly associated with metabolic syndrome in middle-aged and elderly individuals.

The Asian eyelid has distinctive anatomical properties. Although the upper eyelid is reported in the literature to have no subcutaneous fat layer, we have often noticed adipose tissue below the upper eyelid skin during ophthalmic plastic surgeries. The aim of the present study was to examine the anatomical and histological features of subcutaneous adipose tissue in Asian upper eyelids using biopsies and microscopic morphological analysis. A total of 30 Chinese patients (60 upper eyelids) undergoing upper blepharoplasty were evaluated. The subcutaneous fat in the upper eyelids was surgically harvested and examined histologically. This study yielded two main findings. First, upper eyelid subcutaneous fat was found in 28 of the 30 patients. This fat layer was the inferior extension of the eyebrow subcutaneous fat layer, which descended and covered the superior half of the upper eyelid. Second, the lobules of subcutaneous fat in the upper eyelid were surrounded by dense fibrous tissues, and the fat cells were smaller than abdominal adipocytes but similar in size to orbital fat cells. Subcutaneous fat tissue is prominent in the upper eyelids of most Asians and is one important contributor to the bulky appearance of those eyelids. Clin. Anat. 33:338-342, 2020. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Despite being considered present in most vascularised tissues, lymphatic vessels have not been properly shown in human adipose tissue (AT). Our goal in this study is to investigate an unanswered question in AT biology, regarding lymphatic network presence in tissue parenchyma. Using human subcutaneous (S-) and visceral (V-) AT samples with whole mount staining for lymphatic specific markers and three-dimensional imaging, we showed lymphatic capillaries and larger lymphatic vessels in the human VAT. Conversely, in the human SAT, microcirculatory lymphatic vascular structures were rarely detected and no initial lymphatics were found.

Background: Zinc deficiency is highly prevalent and is caused by inadequate dietary intake, malabsorption and removal by treatment in hemodialysis patients. This study investigated the relationship between serum zinc levels and nutritional status in hemodialysis patients., Methods: A cross-sectional study examining 87 hemodialysis patients was performed. The serum concentrations of zinc were studied to evaluate their association with nutritional status, which was assessed by measuring abdominal muscle and fat areas with computed tomography., Results: Serum zinc levels were significantly and positively correlated with subcutaneous and visceral fat areas ( r = 0.299, p < 0.01, and r = 0.298, p < 0.01, respectively), but not abdominal muscle areas. Multiple regression analyses demonstrated that serum zinc levels were a significant independent predictor of visceral fat areas ( p < 0.01), but not subcutaneous fat areas ( p = 0.631)., Conclusions: Our findings suggest that serum zinc levels could play a crucial role in determining abdominal fat mass in hemodialysis patients., Competing Interests: The authors declare no conflict of interest.

Accurate measuring of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) is vital for the research of many diseases. The localization and quantification of SAT and VAT by computed tomography (CT) expose patients to harmful ionizing radiation. Magnetic resonance imaging (MRI) is a safe and painless test. The aim of this paper is to explore a practical method for the segmentation of SAT and VAT based on the iterative decomposition of water and fat with echo asymmetry and least square estimation‑iron quantification (IDEAL-IQ) technology and machine learning. The approach involves two main steps. First, a deep network is designed to segment the inner and outer boundaries of SAT in fat images and the peritoneal cavity contour in water images. Second, after mapping the peritoneal cavity contour onto the fat images, the assumption-free K-means++ with a Markov chain Monte Carlo (AFK-MC 2 ) clustering method is used to obtain the VAT content. An MRI data set from 75 subjects is utilized to construct and evaluate the new strategy. The Dice coefficients for the SAT and VAT content obtained from the proposed method and the manual measurements performed by experts are 0.96 and 0.97, respectively. The experimental results indicate that the proposed method and the manual measurements exhibit high reliability., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The facial fat compartments were described over a decade ago, but their clinical relevance to both deflation and techniques in facial rejuvenation is underappreciated. Although much of the literature following their description has focused on further anatomical elucidation of compartment anatomy, clinical relevance has focused on volumetric compartment augmentation. From the authors' perspective, understanding compartmentalization of facial fat provides an anatomical roadmap of the facial subcutaneous plane and a patient-specific guide for the degree of skin flap dissection in facial rejuvenation. The compartmentalization of facial fat also explains the regional development of cheek deflation in aging. An individualized treatment plan to restore facial shape can be achieved with deep compartment volume augmentation and repositioning of superficial facial fat using the superficial musculoaponeurotic system.

Purpose: Surgical site infection (SSI) in spine surgery remains a significant cause of morbidity and prolonged hospitalization. We intended to document our experience in our center and to highlight possible factors influencing SSI in posterior lumbar fusion surgery., Methods: Between June 2015 and March 2017, 448 consecutive patients with lumbar degenerative disease who underwent classic open transforaminal lumbar interbody fusion were enrolled in the study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analyses were performed to determine risk factors., Results: There was a significant difference between groups in age (P = 0.001), body mass index (P < 0.001), subcutaneous fat thickness (P < 0.001), preoperative American Society of Anesthesiologists (ASA) score (P < 0.001), postoperative hemoglobin (P = 0.003), preoperative serum albumin (P < 0.001), operative time (P < 0.001), operated levels (P < 0.001), postoperative drainage (P = 0.004), time of draining (P < 0.001) and late-presenting dural tear (P = 0.008). Logistic regression analysis of these differences showed that thicker subcutaneous fat thickness, higher preoperative ASA score, lower preoperative serum albumin, and longer time of draining were significantly related to SSI (P < 0.05)., Conclusions: The risk factors for SSI after lumbar fusion surgery are multifactorial. These data should provide a step toward the development of quality improvement measures aimed at reducing complications in high-risk patients. These factors may prove useful for patient counseling and for surgical planning., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Various recently introduced minimally invasive treatment modalities are now widely used for enhancing the aging face. In a special, filler is used to increase the volume of tissue, and so understanding the regional thickness and distribution of the facial superficial fat is essential for optimizing minimally invasive procedures. The aim of this study was to establish the overall facial skin and superficial fat thicknesses using a three-dimensional (3D) scanning system. From 53 adult Korean and Thai embalmed adult cadavers, the undissected and serially-dissected facial specimens were scanned and reconstructed. The facial skin and superficial fat thicknesses on seven facial regions were calculated from the superimposed images. The facial skin tended to become thicker in the order of the radix and dorsum, and the temple, supraorbital, forehead, perioral, cheek, and infraorbital areas. The skin was thinnest at radix and dorsum (1.51 ± 0.55 mm), and thickest in infraorbital region (1.97 ± 0.84 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The superficial fat was thinnest at the radix and dorsum (1.61 ± 1.07 mm), and thickest in the perioral region (5.14 ± 3.31 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The present findings indicate that 3D scanning system can yield crucial anatomical information about depths of the facial skin and superficial fat layers for utilization in various clinical procedures. Clin. Anat. 32:1008-1018, 2019. © 2019 Wiley Periodicals, Inc., (© 2019 Wiley Periodicals, Inc.)

Circumference measurements have been used to estimate muscle cross-sectional area (CSA) in clinical settings. Measurements of thigh circumference are affected by muscle and subcutaneous fat (SF). In fact, SF could increase over a short period. Therefore, clarifying the relationship between thigh circumference and muscle and SF following ACL reconstruction is important. This study's primary purpose was to examine pre- and post-operative changes in thigh circumference, thigh muscles and SF CSAs in both legs. Secondary, the relationship between thigh circumference and muscle and SF CSAs was examined to demonstrate that circumference measurements could be used to detect atrophy. Quadriceps, hamstrings, and SF CSAs at 15, 10, and 5 cm proximal to the patella were measured by MRI pre- and 4 weeks postoperatively to examine how reconstruction affected those tissues in the thighs. The results showed increases in SF CSA (r=0.72 at 10 cm, r=0.67 at 15 cm) greatly affected thigh circumference in females on the surgical side. In males, increases in SF CSA (r=0.83) at 15- and 5-cm and decreases in quadriceps muscle CSA (r=0.73) at 5 cm affected thigh circumference on the surgical side. Thigh circumference measurements might not reflect actual muscle CSA in ACL patients., Competing Interests: Authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation., Objective: To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching., Materials and Methods: At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined., Results: With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin., Conclusion: When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.

Background: The associations between thoracic cage dimension, chest subcutaneous adipose tissue (SAT) depth and outcomes of adults with in-hospital cardiac arrest (IHCA) remain unknown., Methods: We retrospectively evaluated IHCA patients between January 2016 and October 2017. The thoracic cage transverse diameter, internal AP diameter, cross-sectional area, anterior and posterior SAT depths were measured in computed-tomography (CT) images. Using logistic regression models, we determined the adjusted associations between thoracic cage dimension, SAT depths and the prognosis for IHCA. The primary outcome was sustained return of spontaneous circulation (ROSC) and the secondary outcome was survival to hospital discharge., Results: Among 423 IHCA patients, 258 patients achieved ROSC and 70 survived to discharge. Smaller cross-sectional area and posterior SAT depth were significantly related to ROSC. Smaller posterior SAT depth was associated with ROSC. After multivariate adjustment, the smaller cross-sectional area was independently associated with ROSC (Odds ratio [OR] 0.99, 95% confidence interval [95%CI] 0.99-1.00; p = 0.008) and survival to discharge (OR 0.99, 95%CI 0.98-1.00; p = 0.024), and the smaller posterior SAT depth was independently related to ROSC (OR 0.65, 95%CI 0.44-0.96; p = 0.030), whereas no relation to survival to discharge was found., Conclusions: In adults with IHCA, the smaller thoracic cage dimension and posterior SAT depth are associated with better survival. An adjustable compression depth based on the thoracic cage dimension might be better than the "one-size-fits-all" compression depth for resuscitating CA patients. In addition, physicians should pay extra attention to compression efficacy when resuscitating obese patients., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The deep intramuscular approach during buttock augmentation with fat grafting has been associated with a significantly increased risk for pulmonary fat embolism. This study was designed to provide guidance for injection into the subcutaneous fat., Methods: The authors investigated 150 Caucasian individuals with an equal distribution of men and women (n = 75 each) and a balanced distribution of age (n = 30 per decade: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years) and body mass index (n = 50 per group: ≤24.9 kg/m, between 25.0 and 29.9kg/m, and ≥30 kg/m). Ultrasound-based measurements were conducted of the thickness of the total, superficial, and deep gluteal fatty layers., Results: An increase in body mass index of 1.0 kg/m corresponded to an increase of 3 mm of the total gluteal subcutaneous fat of men and a 4-mm increase of the total gluteal subcutaneous fat in women. With increasing age, the thickness of the deep fatty layer increased, whereas with increasing body mass index the thickness of the superficial layer primarily increased. Formulas were generated to estimate the total thickness of the gluteal subcutaneous fatty layer for men [total thickness (in millimeters) = -33.56 + (age × 0.078) + (body mass index × 3.042)] and women [total thickness (in millimeters) = -56.997 + (age × 0.1) + (body mass index × 3.86)]., Conclusions: Knowing the total thickness of the gluteal subcutaneous fat (i.e., the safe space) allows surgeons to estimate their operating range for cannula motion even if no ultrasound machine is available during buttock augmentation with fat grafting. This can increase safety, potentially reducing the number of adverse events.

Background: Polydioxanone (PDO) sutures have been widely used to tighten and lift the face. However, why the complexion brightens and skin elasticity is maintained with a smaller facial outline after a PDO monofilament thread treatment remains unclear., Aims: We aimed to determine what significant changes occur in the tissue over time when a PDO suture is inserted., Methods: We selected four White Yucatan variety pygmy pigs with skin that most closely resembles the structure of human skin. 4-0 PDO thread was inserted into the subcutaneous fat. Tissue samples were obtained at 4, 12, 24, and 48 weeks. For the histologic analysis, H&E staining, Masson trichrome staining, and anti-smooth muscle actin immunohistochemical staining techniques were used., Results: Nine histological findings appeared over time, and these findings are summarized as five tissue changes., Conclusions: PDO sutures cause specific changes to the surrounding tissues that result in neo-collagenesis, a fibrous merging effect, fat reduction, tissue contracture, and an improved vascular environment. The results of this study explain the positive changes described in previous clinical research., (© 2018 Wiley Periodicals, Inc.)

Background: Soft-tissue filler injections for the treatment of facial aging can result in different skin surface effects depending on the targeted facial fat compartment and fascial plane. This work investigates the tissue response of defined amounts of soft-tissue filler material injected into superficial and deep facial fat compartments by means of the calculation of the surface-volume coefficient., Methods: Four fresh frozen cephalic specimens obtained from human donors (three female and one male; mean age, 74.96 ± 22.6 years; mean body mass index, 21.82 ± 6.3 kg/m) were studied. The superficial and deep lateral forehead compartments, deep temporal fat pad, sub-orbicularis oculi fat compartment, and deep medial cheek fat compartment were injected with aliquots of 0.1 cc of contrast-enhanced material and scanned using three-dimensional surface imaging, resulting in a total of 226 injection and scanning procedures., Results: The sub-orbicularis oculi fat compartment revealed the highest correlation coefficient (rp = 0.992; p < 0.001) and the highest surface-volume coefficient (0.94). The compartment with the lowest tissue response was the deep medial cheek fat compartment (rp = 0.745; p < 0.001; surface-volume coefficient = 0.29), followed by the deep lateral forehead compartment (rp = 0.814; p < 0.001; surface-volume coefficient = 0.68), superficial lateral forehead compartment (rp = 0.824; p < 0.001; surface-volume coefficient = 0.74), and deep temporal fat pad (rp = 0.947; p < 0.001; overall surface-volume coefficient = 0.64)., Conclusions: These results, confirmatory in their nature to current injection strategies, provide evidence for the validity and reliability of the surface-volume coefficient. Injection procedures should be targeted in terms of facial fat compartments and fascial planes for a desired aesthetic outcome, as each fat compartment and fascial plane has unique tissue responses to injected soft-tissue fillers.

In healthy blood vessels, albumin crosses the endothelium to leave the circulation by transcytosis. However, little is known about the regulation of albumin transcytosis or how it differs in different tissues; its physiological purpose is also unclear. Using total internal reflection fluorescence microscopy, we quantified transcytosis of albumin across primary human microvascular endothelial cells from both lung and skin. We then validated our in vitro findings using a tissue-specific knockout mouse model. We observed that albumin transcytosis was saturable in the skin but not the lung microvascular endothelial cells, implicating a receptor-mediated process. We identified the scavenger receptor CD36 as being both necessary and sufficient for albumin transcytosis across dermal microvascular endothelium, in contrast to the lung where macropinocytosis dominated. Mutations in the apical helical bundle of CD36 prevented albumin internalization by cells. Mice deficient in CD36 specifically in endothelial cells exhibited lower basal permeability to albumin and less basal tissue edema in the skin but not in the lung. Finally, these mice also exhibited a smaller subcutaneous fat layer despite having identical total body weights and circulating fatty acid levels as wild-type animals. In conclusion, CD36 mediates albumin transcytosis in the skin but not the lung. Albumin transcytosis may serve to regulate fatty acid delivery from the circulation to tissues.

Objective: There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy., Material and Methods: The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy., Results: The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the retinacula cutis (composed of fibrous connective tissue); layer 3: superficial musculo-aponeurotic system (SMAS); layer 4: deep fat; and layer 5: periosteum or deep fascia. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues., Conclusions: The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures., (© 2019 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

The cull ewes represent an important part of sheep flock. However, this category of animal is often submitted to under nutrition leading to poor BW and skeletal carcasses. Their rehabilitation using a high energy diet can be an alternative to improve their body condition. The objective of this experiment was to study the BW gain and carcass characteristics of Barbarine cull ewes using rosemary (Rosmarinus officinalis L.) distillation residues (RR) and extruded linseed. For this, 28 ewes above 6 years old and 33±0.5 kg of BW were divided into four groups: CCC was fed 500 g of barley-straw with concentrate, RCC received 300 g of straw and 200 g of RR as basal diet with concentrate; whereas two other groups received the experimental concentrate, containing 10% of linseed, with 500 g of straw for CLC and 300 g of straw plus 200 g of RR for RLC group. At the end of experiment (90 days), all animals were slaughtered. For all ewes, the daily concentrate intake averaged 700 g; the average daily gain was 131 g and the slaughter BW 43.4 kg without significant difference between groups. Neither basal diet nor concentrate type did affect the carcass' weight, yield and composition. In addition, the organ's proportions were similar for all groups. The RR intake slightly improved muscle's protein content (P=0.03) and tended to decrease initial pH (P=0.06) and to increase meat redness (P=0.06), whereas linseed concentrate had no effect on meat color and its chemical composition. The subcutaneous fat color and firmness score relived a good quality trade for carcasses from all diets, in spite of higher yellowness and lower firmness recorded for linseed diet (P&lt;0.05), which were moderately improved by rosemary combination with linseed. To conclude, the Barbarine cull ewes could gain up to 120 g/day in BW. The used diets permitted this BW gain without undesirable effects on carcass characteristics and meat quality. However, the study of meat fatty acid profile and antioxidant status should continue.

Human milk oligosaccharides (HMOs) are bioactive glycans linked with health benefits to both the breast-fed infant and lactating mother. We hypothesized that HMOs are present before lactation, already during pregnancy, and are influenced by maternal body composition. In a pilot study, we investigated individual and temporal variations in HMO composition and concentration in maternal serum at gestational weeks 10-14 ( visit 1), 20-24 ( visit 2), and 30-35 (visit 3) (V1, V2, and V3, respectively) and associations with maternal body composition. HMOs were quantified by HPLC and confirmed by enzymatic digest and mass spectrometry. Associations of maternal prepregnancy body mass index (BMI), subcutaneous adipose tissue (SAT) thickness, and adipokines with absolute and relative HMO concentrations were analyzed by Spearman correlation. We identified 16 HMOs and 2 oligosaccharides not common to human milk. HMO concentration and composition varied with gestational age and secretor status. HMO concentration increased with gestational age and changed from a predominantly sialylated profile at V1 to a more balanced fucosylated-to-sialylated ratio at V3, mostly due to a profound increase in 2'-fucosyllactose (2'-FL), reflecting secretor phenotype. In secretor-positive women, BMI was negatively correlated with 2'-FL at V2. SAT at V1 and V2 were strongly negatively correlated with 2'-FL concentrations. This pilot study shows that prenatal HMOs are present in maternal serum, suggesting roles for HMOs already during pregnancy. Our result that maternal body composition is associated with prenatal HMOs might indicate that maternal metabolism modulates HMO composition with unknown implications for maternal and fetal health already during pregnancy.

Chemokines are members of a large family of chemotactic cytokines that signal through their receptors to mediate leukocyte recruitment during inflammation and homeostasis. The chemokine receptor CXCR2 has largely been associated with neutrophil recruitment. However, there is emerging evidence of roles for chemokines and their receptors in processes other than leukocyte migration. We have previously demonstrated that CXCR2 knockout (KO) mice have thinner skin compared to wild-type mice. Herein we demonstrate that this is due to a thinner subcutaneous adipose layer, as a result of fewer and smaller individual adipocytes. We observe a similar phenotype in other fat depots and present data that suggests this may be due to reduced expression of adipogenesis related genes associated with adipocyte specific CXCR2 signaling. Interestingly, this phenotype is evident in female, but not male, CXCR2 KO mice. These findings expand our understanding of nonleukocyte related chemokine receptor functions and help to explain some previously observed adipose-related phenotypes in CXCR2 KO mice., (©2018 The Authors. Society for Leukocyte Biology Published by Wiley Periodicals, Inc.)

Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is to provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications will be reviewed along with measures to optimize patient safety and outcomes.

Background: Injection of soft-tissue fillers into the facial fat compartments is frequently performed to ameliorate the signs of facial aging. This study was designed to investigate the functional anatomy of the deep facial fat compartments and to provide information on the effects of injected material in relation to age and gender differences., Methods: Forty fresh frozen cephalic specimens of 17 male and 23 female Caucasian body donors (mean age, 76.9 ± 13.1 years; mean body mass index, 23.6 ± 5.3 kg/m(2)) were investigated. Computed tomographic and magnetic resonance imaging procedures were carried out using colored contrast-enhanced materials with rheologic properties similar to commercially available soft-tissue fillers. Anatomical dissections were performed to guide conclusions., Results: No statistically significant influences of age or gender were detected in the investigated sample. Increased amounts of injected contrast agent did not correlate with inferior displacement of the material in any of the investigated compartments: deep pyriform, deep medial cheek, deep lateral cheek, deep nasolabial (located within the premaxillary space), and the medial and lateral sub-orbicularis oculi fat., Conclusions: Increasing volume in the deep midfacial fat compartments did not cause inferior displacement of the injected material. This underscores the role of deep soft-tissue filler injections (i.e., in contact with the bone) in providing support for overlying structures and resulting in anterior projection.

Background: With rising prevalence of obesity, increasing number of gluteal injections would be expected to fail in intramuscular (IM) drug delivery., Study Question: This study evaluated ventral gluteal fat thickness (VGT) on adult magnetic resonance imaging of pelvis and correlated it with the subjects' body mass index (BMI), weight, and height to establish evidence-based clinical estimates of individualized needle length and suitability of ventral gluteal site for IM injections., Design: Retrospective review., Study Design, Measures and Outcomes: Three hundred fifty adult (224 women, 126 men) magnetic resonance imaging scans of pelvis were reviewed to measure the VGT as the distance between the skin and the nearest edge of the gluteus medius muscle at the recommended ventral gluteal injection site. VGT was correlated with BMI, weight, and height by multivariate analysis., Results: Fifty-three (49 women, 4 men) subjects had VGT greater than 3.3 cm, and 146 (106 women, 40 men) subjects had VGT greater than 2.0 cm. The Pearson correlation coefficient between VGT and BMI was 0.82 for women and 0.81 for men. The difference between the VGT in men and women of comparable BMI was statistically significant (P < 0.001). BMI of 30 in women and 35 in men seem to be upper limits for successful ventral gluteal IM injections with 3.75-cm (1.5-inch) hypodermic needle. The expected failure rate of ventral gluteal IM delivery with the 3.75-cm needle is 71% in women with BMI >30, and 60% in men with BMI >35., Conclusion: BMI is reliably predictive of VGT in both men and women for selecting appropriate needle length for IM injections at this site. Standard needles would fail in IM delivery at this site in a considerable proportion of obese adults. Because of high prevalence of obesity in individuals with severe mental illness, our findings could significantly impact acute and maintenance therapy with injectable tranquillizers and antipsychotics.

Background We investigated whether visceral adiposity is associated with more aggressive disease at prostatectomy. Materials and methods Four hundred and seventy-four patients referred for postoperative adjuvant or salvage radiotherapy were included in this study. Primary endpoints were positive surgical margins (pSM) or extracapsular extension (ECE). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were manually contoured. Univariate and multivariate logistic regression was performed. Results In univariate analysis, VAT volume (p = 0.006), adipose tissue ratio (VAT/SAT, p = 0.003), density of the SAT (p = 0.04), as well as age (p < 0.001) were associated with pSM. In the univariate analysis, SAT density was associated with a trend towards a higher rate of ECE (p = 0.051) but visceral fat volume (p = 0.01), as well as the adipose tissue ratio (p = 0.03) were both protective factors. None of the adipose tissue measurements or BMI had an influence on biochemical recurrence or overall survival (all p ≥ 0.5). Conclusions SAT-volume and increased SAT-density were generally associated with more aggressive prostate cancers whereas VAT as a protective factor. These findings emphasize a possible mechanism for the association between obesity and prostate cancer aggressiveness.

Objective: To compare muscle thickness and subcutaneous fat in cystic fibrosis (CF) patients and healthy controls using ultrasonography (US), and to correlate US findings with nutritional, clinical and functional variables., Methods: Patients aged 6 to 18 years old with a diagnosis of CF and healthy controls were included. Participants underwent anthropometric measurements, an ultrasonographic evaluation of muscle thickness and subcutaneous fat in the triceps, quadriceps, and gastrocnemius regions, and skinfold thickness measurements. Body fat percentage was estimated using skinfold measurement. Subjects with CF also underwent a pulmonary function assessment using spirometry., Results: We studied 39 CF patients and 45 controls. Alower body mass index was observed in CF patients (p=0.011). Body composition and muscle thickness were similar between the groups. Only calf (p=0.023) circumference and femur diameter (p<0.001) were lower in CF patients. Although there were no significant between-group differences in the comparison of US measurements of subcutaneous fat, CF patients exhibited decreased skinfold thickness in the triceps (p=0.031) and quadriceps (p=0.019). Moreover, there were weak and moderate correlations of US quadricep thickness with forced vital capacity (FVC) and lean mass, respectively. Moderate correlations of the triceps, quadriceps and gastrocnemius between US subcutaneous fat and skinfold measurements were found., Conclusions: Patients with CF presented a reduction in subcutaneous fat content. Muscle thickness correlated with FVC and nutritional parameters. In addition, US findings correlated positively with skinfold measurements.

Obesity is increasingly prevalent and associated with increased risk of developing type 2 diabetes, cardiovascular diseases, and cancer. Magnetic resonance imaging (MRI) is an accurate method for determination of body fat volume and distribution. However, quantifying body fat from numerous MRI slices is tedious and time-consuming. Here we developed a deep learning-based method for measuring visceral and subcutaneous fat in the abdominal region of mice. Congenic mice only differ from C57BL/6 (B6) Apoe knockout (Apoe-/-) mice in chromosome 9 that is replaced by C3H/HeJ genome. Male congenic mice had lighter body weight than B6-Apoe-/- mice after being fed 14 weeks of Western diet. Axial and coronal T1-weighted sequencing at 1-mm-thickness and 1-mm-gap was acquired with a 7T Bruker ClinScan scanner. A deep learning approach was developed for segmenting visceral and subcutaneous fat based on the U-net architecture made publicly available through the open-source ANTsRNet library-a growing repository of well-known neural networks. The volumes of subcutaneous and visceral fat measured through our approach were highly comparable with those from manual measurements. The Dice score, root-mean-square error (RMSE), and correlation analysis demonstrated the similarity between two methods in quantifying visceral and subcutaneous fat. Analysis with the automated method showed significant reductions in volumes of visceral and subcutaneous fat but not non-fat tissues in congenic mice compared to B6 mice. These results demonstrate the accuracy of deep learning in quantification of abdominal fat and its significance in determining body weight., Competing Interests: The authors have declared that no competing interests exist.

Objective: To study the relationship of area- and volumetric-based visceral and subcutaneous adipose tissue (VAT and SAT) by MRI and their ratio in subjects with impaired glucose metabolism from the general population., Methods: Subjects from a population-based cohort with established prediabetes, diabetes and healthy controls without prior cardiovascular diseases underwent 3 T MRI. VAT and SAT were assessed as total volume and area on a single slice, and their ratio (VAT/SAT) was calculated. Clinical covariates and cardiovascular risk factors, such as hypertension and glycemic state were assessed in standardized fashion. Univariate and adjusted analyses were conducted., Results: Among 384 subjects (age: 56.2 ± 9.2 years, 58.1% male) with complete MRI data available, volumetric and single-slice VAT, SAT and VAT/SAT ratio were strongly correlated (all >r = 0.89). Similarly, VAT/SAT volume ratio was strongly correlated with VAT volume but not with SAT (r = 0.72 and r = -0.21, respectively). Significant higher levels of VAT, SAT and VAT/SAT ratio were found in subjects with impaired glucose metabolism (all p ≤ 0.01). After adjustment for potential cardiovascular confounders, VAT volume and VAT/SAT volume ratio remained significantly higher in subjects with impaired glucose metabolism (VAT volume = 6.9 ± 2.5 l and 3.4 ± 2.3 l; VAT/SAT volume ratio = 0.82 ± 0.34 l and 0.49 ± 0.29 l in patients with diabetes and controls, respectively, all p < 0.02), whereas the association for SAT volume attenuated. Additionally, there was a decreasing effect of glycemic status on VAT/SAT volume ratio with increasing body mass index and waist circumference (p < 0.05)., Conclusions: VAT volume and VAT/SAT volume ratio are associated with impaired glucose metabolism, independent of cardiovascular risk factors or MRI-based quantification technique, with a decreasing effect of VAT/SAT volume ratio in obese subjects. Advances in knowledge: Quantification of VAT volume and VAT/SAT volume ratio by MRI represents a reproducable biomarker associated with cardiometabolic risk factors in subjects with impaired glucose metabolism, while the association of VAT/SAT volume ratio with glycemic state is attenuated in obese subjects.

Objective: To determine a relationship between increased body mass index (BMI) and fatty involution of the thymus in subjects aged between 20 and 30 years., Methods: CT images of 94 patients aged between 20 and 30 years were reviewed. Quantitative thymic mean attenuation was recorded and qualitative thymic attenuation was assigned to 1 of 4 possible grades. BMI and subcutaneous fat thickness were documented. Correlations between thymic attenuation, and BMI and subcutaneous fat thickness were assessed using linear regression models. Differences in thymic attenuation in overweight vs normal weight patients were assessed using t-test and Pearson Χ 2 analysis., Results: Low mean thymic attenuation values were associated with higher patient BMI (p = 0.024). Normal weight patients had a mean quantitative thymic attenuation of 15.5 Hounsfield unit and overweight patients had a mean quantitative thymic attenuation of -16.4 Hounsfield unit (p = 0.0218). There was a significant association between increasing subcutaneous fat thickness and reduced mean quantitative thymic attenuation (p < 0.0001). There was also a significant difference in subcutaneous fat thickness when comparing qualitatively assessed thymic Grade 0 with grades 2 and 3 (p = 0.027 and 0.001 respectively); and Grade 1 with Grade 3 (p = 0.001)., Conclusion: In patients between 20 and 30 years old, the degree of thymic fatty infiltration is related to BMI. Advances in knowledge: Multidetector CT can assess fatty involution of the thymus gland. This retrospective study demonstrates a relationship between BMI and thymus gland fatty involution. Subjects with increased subcutaneous fat have decreased mean thymus gland attenuation.

Background: The complex study of adipose tissue in women with type 2 diabetes mellitus (T2DM) is of importance for the clinical course and prognosis of the disease., Aim: To study the distribution of adipose tissue in Bulgarian females with T2DM., Patients and Methods: The study included 92 women with T2DM (age range 40-60 years). The control group consisted of 40 age-matched women. Measurement parameters: height, weight, 9 skinfolds (sf) - sfTriceps, sfBiceps brachii, sfForearm, sfSubscapular, sfXrib, sfAbdomen, sfSuprailiaca, sfThigh, and sfCalf; bioelectrical impedance analysis - % body fat tissue and visceral fat tissue. Calculated indexes: body mass index (BMI), the ratio sfTrunk to sfLimbs, the ratio skin folds upper half of body/skin folds lower half of body, fat mass and subcutaneous fat mass., Results: Statistically significant differences were found in the means of sfTriceps, sfXrib, sfThigh, sfCalf, % body fat tissue, visceral fat tissue, and fat mass and subcutaneous fat mass between the diabetic and healthy women. The body composition of diabetic females aged 40-60 years contained a larger adipose component than controls. Visceral adipose tissue which determines the body composition is a reliable indicator of the health risks in diabetic women., Conclusion: The pattern of subcutaneous adipose tissue distribution in diabetic females aged 40-60 yrs was primarily in the upper torso region and less so in the limbs. In the controls adipose tissue is accumulated primarily in the limbs and in the lower part of the body.

Background: Thinned perforator flaps, reported techniques, and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography., Methods: Three stratified fattiness groups consisting of 30 donors were formed for thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh flaps. Thickness of the superficial fat and the deep fat layers was measured at specific points in donor sites of the three flaps and the proportion of superficial and deep fat layers to exclude to reach the target flap thickness (4, 6, and 8 mm) was calculated., Result: The median proportion for the superficial fat layer varies depending on donor fattiness. The estimated percentage reduction of thickness after thin flap elevation along superficial fascia was approximately one-third of the whole layer. A variable proportion of each fat layer needs to be excluded to obtain required thinness and in very thick groups, part of the superficial fat layer must be removed to reach any of the target thicknesses for the three flaps., Conclusions: The present study demonstrated the frequent need for superficial fat layer manipulation when obtaining a thin perforator flap. To cope with various combinations of donor-site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control superficial fat layer thickness.